Korean J Ophthalmol.  2017 Apr;31(2):102-107. 10.3341/kjo.2017.31.2.102.

Analgesic Effect of Topical Sodium Diclofenac before Retinal Photocoagulation for Diabetic Retinopathy: A Randomized Double-masked Placebo-controlled Intraindividual Crossover Clinical Trial

• Ramezani A
• Entezari M
• Shahbazi M
• Semnani Y
• Nikkhah H
• Yaseri M

• KMID: 2373465
• DOI: http://doi.org/10.3341/kjo.2017.31.2.102

Abstract

PURPOSE
To evaluate the analgesic effect of topical sodium diclofenac 0.1% before retinal laser photocoagulation for diabetic retinopathy.
METHODS
Diabetic patients who were candidates for peripheral laser photocoagulation were included in a randomized, placebo-controlled, intraindividual, two-period, and crossover clinical trial. At the first session and based on randomization, one eye received topical sodium diclofenac 0.1% and the other eye received an artificial tear drop (as placebo) three times before laser treatment. At the second session, eyes were given the alternate drug. Patients scored their pain using visual analogue scale (max, 10 cm) at both sessions. Patients and the surgeon were blinded to the drops given. Difference of pain level was the main outcome measure.
RESULTS
A total of 200 eyes of 100 patients were enrolled. Both treatments were matched regarding the applied laser. Pain sensation based on visual analogue scale was 5.6 ± 3.0 in the treated group and 5.5 ± 3.0 in the control group. The calculated treatment effect was 0.15 (95% confidence interval, −0.27 to 0.58; p = 0.486). The estimated period effect was 0.24 (p = 0.530) and the carryover effect was not significant (p = 0.283).
CONCLUSIONS
Pretreatment with topical sodium diclofenac 0.1% does not have any analgesic effect during peripheral retinal laser photocoagulation in diabetic patients.

Keyword

Analgesic effect; Diabetic retinopathy; Laser photocoagulation; Topical sodium diclofenac

MeSH Terms

Diabetic Retinopathy*
Diclofenac*
Humans
Light Coagulation*
Outcome Assessment (Health Care)
Random Allocation
Retinaldehyde*
Sensation
Sodium*
Tears
Diclofenac
Retinaldehyde
Sodium

Figure

• 

  Fig. 1 Drop lines showing the changes in pain scores in each subject for the two treatment groups in every session, separately.

Reference

1. Klein R, Klein BE, Moss SE, Cruickshanks KJ. The Wisconsin Epidemiologic Study of diabetic retinopathy. XIV: ten-year incidence and progression of diabetic retinopathy. Arch Ophthalmol. 1994; 112:1217–1228.

2. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study (DRS) findings, DRS report number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology. 1981; 88:583–600.

3. Cook HL, Newsom RS, Mensah E, et al. Entonox as an analgesic agent during panretinal photocoagulation. Br J Ophthalmol. 2002; 86:1107–1108.

4. Fry LL. Efficacy of diclofenac sodium solution in reducing discomfort after cataract surgery. J Cataract Refract Surg. 1995; 21:187–190.

5. Herbort CP, Jauch A, Othenin-Girard P, et al. Diclofenac drops to treat inflammation after cataract surgery. Acta Ophthalmol Scand. 2000; 78:421–424.

6. Epstein RL, Laurence EP. Effect of topical diclofenac solution on discomfort after radial keratotomy. J Cataract Refract Surg. 1994; 20:378–380.

7. Sher NA, Golben MR, Bond W, et al. Topical bromfenac 0.09% vs. ketorolac 0.4% for the control of pain, photophobia, and discomfort following PRK. J Refract Surg. 2009; 25:214–220.

8. Durrie DS, Kennard MG, Boghossian AJ. Effects of nonsteroidal ophthalmic drops on epithelial healing and pain in patients undergoing bilateral photorefractive keratectomy (PRK). Adv Ther. 2007; 24:1278–1285.

9. Salz JJ, Reader AL 3rd, Schwartz LJ, Van Le K. Treatment of corneal abrasions with soft contact lenses and topical diclofenac. J Refract Corneal Surg. 1994; 10:640–646.

10. Lesnoni G, Coppe AM, Manni G, et al. Analgesic effect of topical diclofenac versus betamethasone after posterior segment surgery. Retina. 1995; 15:34–36.

11. Weinberger D, Ron Y, Lichter H, et al. Analgesic effect of topical sodium diclofenac 0.1% drops during retinal laser photocoagulation. Br J Ophthalmol. 2000; 84:135–137.

12. Chiu HH, Wu PC. Manual acupuncture for relieving pain associated with panretinal photocoagulation. J Altern Complement Med. 2011; 17:915–921.

13. Mirshahi A, Lashay A, Roozbahani M, et al. Pain score of patients undergoing single spot, short pulse laser versus conventional laser for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol. 2013; 251:1103–1107.

14. Ku EC, Lee W, Kothari HV, Scholer DW. Effect of diclofenac sodium on the arachidonic acid cascade. Am J Med. 1986; 80:18–23.

15. Zakrzewski PA, O'Donnell HL, Lam WC. Oral versus topical diclofenac for pain prevention during panretinal photocoagulation. Ophthalmology. 2009; 116:1168–1174.

16. Esgin H, Samut HS. Topical ketorolac 0.5% for ocular pain relief during scatter laser photocoagulation with 532 nm green laser. J Ocul Pharmacol Ther. 2006; 22:460–464.

17. Ellis PP, Pfoff DS, Bloedow DC, Riegel M. Intraocular diclofenac and flurbiprofen concentrations in human aqueous humor following topical application. J Ocul Pharmacol. 1994; 10:677–682.

18. Scott J, Huskisson EC. Graphic representation of pain. Pain. 1976; 2:175–184.